Chest radiographic findings in children with asplenia syndrome.

Background: Early diagnosis of asplenia syndrome is important because prophylactic antibiotic and proper vaccination will prevent serious infection. Most children with asplenia syndrome present with symptoms of congenital heart disease. Chest X-ray is usually the first line imaging modality. Objective: Define useful findings in chest radiograph that could suggest the diagnosis of asplenia syndrome. Methods: Chest radiographs of pediatric patients who had asplenia syndrome diagnosed between January 1, 2002 and June 30, 2008 in a single institute were retrospectively reviewed for the positions of the visceral organs in the chest and abdomen. Results: Three hundred seventy one chest radiographs of 30 patients were reviewed. The mean age at diagnosis was 3 years old. Asplenia was diagnosed by ultrasound in 27 patients, by CT scan in two patients, and by damaged red blood cell scintigraphy in one patient. Six important findings detected from chest radiographs were, 1) bilateral minor fissures, 16 cases (53%), 2) bilateral eparterial bronchi, 16 cases (53%), 3) ipsilateral side of stomach and liver, 12 cases (40%), 4) ipsilateral side of minor fissure or eparterial bronchus and stomach, 10 cases (33%), 5) symmetrical transverse lie of the liver, nine cases (30%), and 6) contralateral side of minor fissure or eparterial bronchus and the liver in seven cases (23%). All except two patients (93%) had at least one of the above findings. All patients had congenital heart diseases. Most of the heart diseases were pulmonary atresia or pulmonary stenosis (88%) and single ventricle (85%). Conclusion: Chest radiographs have high sensitivity in suggesting the diagnosis of asplenia syndrome, when detecting one or more of the above findings, particular in patients with congenital heart disease and decreased pulmonary vasculature.

Left Minor Fissures of the Lungs in Korean / 체질인류학회지

Accessory fissures serve not only as natural barriers against infection but also help in localizing any focal pulmonary parenchymal diseases and in distinguishing pleural from parenchymal diseases. Knowledge of these fissures might be useful in differentiating unusual forms of atelectasis or consolidation occuring adjacent to the fissure. Left minor fissure (LMF) is a kind of unusual accessory fissures of the left lung, which separates adjacent segments of the upper lobe as clefts of various depths lined by two layers of visceral pleura. In this study, 4 cases of LMFs found in the left upper lobe during a routine dissection of 36 cadavers were observed. Of the 4 cases, 3 cases were true LMFs which located between the anterior segment of the upper lobe and superior segment of lingula, and 1 case was considered as left azygos fissure. Among the true LMFs, 2 LMFs coursed horizontally and 1 LMF coursed upward obliquely along the costal surface. The depth of LMFs was 0.5~1.2 cm and the length was 5~8 cm.